- Definition. Involuntary leakage of urine that is suffiecient enough in frequency and amount to cause physical and/or emotional distress.
- Incidence. Highly prevalent in women across their adult lifespan and severity increases linearly with age in women across their adult lifespan: 4–8% ultimately seek medical attention. One in three women aged >60 years has a bladder control problem.
- Mechanism. Continence and urination involve a balance between urethral closure and detrusor (bladder smooth muscle) activity. Urethral pressure normally exceeds bladder pressure, resulting in urine remaining in the bladder. Intra-abdominal pressure increases (coughing, sneezing) are normally transmitted to both urethra and bladder equally, maintaining continence. Disruption of this balance leads to various types of incontinence.
Diagnosis (six basic components)
1 History. A detailed history is important to determine the severity of symptoms and rule out medication causes. Emotional distress often does not correlate well with the amount of urine loss that can be demonstrated.
2 Physical examination (three areas):
- General examination to rule out delirium and, atrophic urethritis, restricted mobility, or stool impaction.
- Urogynecologic examination may reveal severe vulvar excoriation from continual dampness. The vaginal tissue should be inspected for signs of atrophy, stenosis, bladder neck mobility (Q-tip test), and atrophic urethritis. The patient is asked to cough repeatedly or undergo a Valsalva maneuver with a full bladder in the lithotomy or standing position to induce urine leakage. Rectal examination can evaluate rectal sphincter tone or the presence of fecal impaction.
3 Urinalysis and urine culture. Many relevant metabolic and urinary tract disorders can be screened by a simple urinalysis. A culture is essential to rule out infection before proceeding with further evaluation.
4 Residual urine volume after voiding. A catheterized post-void residual (PVR) urine specimen should be obtained to exclude urinary retention (normal PVR ≤100 mL) or infection.
5 Frequency–volume bladder chart.
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